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| Study casts doubt on breast cancer testing | Study casts doubt on breast cancer testing |
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| Internationally renowned cancer experts have cast fresh doubt on the benefits of breast cancer screening programmes, warning that they save fewer lives than previously thought. | Internationally renowned cancer experts have cast fresh doubt on the benefits of breast cancer screening programmes, warning that they save fewer lives than previously thought. |
| More than 2 million women in the UK have a mammogram – an X-ray of the breast to detect possible early-stage tumours – every year. But the benefits of screening have been questioned, with critics pointing out that it can also cause harm. Some women undergo biopsies only to be given the all-clear, while others may be treated for a small growth that would not trouble them in their lifetime. | More than 2 million women in the UK have a mammogram – an X-ray of the breast to detect possible early-stage tumours – every year. But the benefits of screening have been questioned, with critics pointing out that it can also cause harm. Some women undergo biopsies only to be given the all-clear, while others may be treated for a small growth that would not trouble them in their lifetime. |
| A major review in 2012, commissioned by the then cancer tsar, Prof Sir Mike Richards, concluded that the harm was greater than women had been told but that the screening programme still saved lives. | A major review in 2012, commissioned by the then cancer tsar, Prof Sir Mike Richards, concluded that the harm was greater than women had been told but that the screening programme still saved lives. |
| The latest salvo in the war over breast cancer screening, however, threatens to reopen the debate. Leading cancer epidemiologists have gone back to the original trials carried out in Sweden in the 1960s and 1970s, which provided the evidence on which the UK and other screening programmes were based. Those trials found that screening could prevent 20-25% of breast cancer deaths. In a paper in the Journal of the Royal Society of Medicine, the experts say the methodology of the study was wrong and that figure is far too high. They believe that any reduction of deaths is probably less than 10%. | The latest salvo in the war over breast cancer screening, however, threatens to reopen the debate. Leading cancer epidemiologists have gone back to the original trials carried out in Sweden in the 1960s and 1970s, which provided the evidence on which the UK and other screening programmes were based. Those trials found that screening could prevent 20-25% of breast cancer deaths. In a paper in the Journal of the Royal Society of Medicine, the experts say the methodology of the study was wrong and that figure is far too high. They believe that any reduction of deaths is probably less than 10%. |
| They point out that advanced cancers most likely to cause death have not dropped dramatically in areas that have had screening programmes for many years. “Contrary to expectations, numerous studies in North America, Europe and Australia have shown that the rates of advanced breast cancer have not declined in countries where most women regularly attend mammography screening,” said the lead author, Prof Philippe Autier, from the Institute of Global Public Health, a joint health research initiative of Strathclyde University and the Lyon-based International Prevention Research Institute (iPRI). | They point out that advanced cancers most likely to cause death have not dropped dramatically in areas that have had screening programmes for many years. “Contrary to expectations, numerous studies in North America, Europe and Australia have shown that the rates of advanced breast cancer have not declined in countries where most women regularly attend mammography screening,” said the lead author, Prof Philippe Autier, from the Institute of Global Public Health, a joint health research initiative of Strathclyde University and the Lyon-based International Prevention Research Institute (iPRI). |
| That is in contrast to cervical and bowel cancer screening, they say. Deaths have halved in the past couple of decades but the drop is to do with better treatment, rather than mammograms. | That is in contrast to cervical and bowel cancer screening, they say. Deaths have halved in the past couple of decades but the drop is to do with better treatment, rather than mammograms. |
| Prof Richard Sullivan from the Institute of Cancer Policy, King’s College London, said the study was carried out because India, Brazil, China and other developing countries are being pressed to set up expensive screening programmes that may or may not be the best use of limited money to fight cancer. “We are working in India, where there is enormous pressure from interested groups to put in breast screening,” he said. | Prof Richard Sullivan from the Institute of Cancer Policy, King’s College London, said the study was carried out because India, Brazil, China and other developing countries are being pressed to set up expensive screening programmes that may or may not be the best use of limited money to fight cancer. “We are working in India, where there is enormous pressure from interested groups to put in breast screening,” he said. |
| Related: If you suspect you have cancer, don't be like me – get it checked out | Jenni Murray | |
| To try to bring useful new evidence to bear, Autier and Prof Peter Boyle, director of the University of Strathclyde Institute of Global Public Health at iPRI, who are both highly skilled epidemiologists, looked at the original trials. They found “major fundamental errors in the statistical analysis”, said Sullivan. “We have tried to be very pure about this. Actually there is a real intrinsic problem with the statistical methodology used. It was not correct. There was a very small benefit.” | To try to bring useful new evidence to bear, Autier and Prof Peter Boyle, director of the University of Strathclyde Institute of Global Public Health at iPRI, who are both highly skilled epidemiologists, looked at the original trials. They found “major fundamental errors in the statistical analysis”, said Sullivan. “We have tried to be very pure about this. Actually there is a real intrinsic problem with the statistical methodology used. It was not correct. There was a very small benefit.” |
| The paper is important for countries that already have screening programmes, he said. “At some point Britain will have to re-review its policy and this will be one of the pieces. My feeling is, give it another two years and Britain may need to constitute another group in 2017. The screening debate is far from over.” | The paper is important for countries that already have screening programmes, he said. “At some point Britain will have to re-review its policy and this will be one of the pieces. My feeling is, give it another two years and Britain may need to constitute another group in 2017. The screening debate is far from over.” |
| But Prof Julietta Patnick, director of the NHS cancer screening programmes, managed by Public Health England, fell back on the conclusions of the review set up by Richards. | But Prof Julietta Patnick, director of the NHS cancer screening programmes, managed by Public Health England, fell back on the conclusions of the review set up by Richards. |
| “A 2012 independent UK review of breast screening looked at the evidence from these trials and estimated that inviting women aged 50-70 for screening reduces mortality from breast cancer in the population invited by 20% and saves an estimated 1,300 lives a year in the UK,” she said. | “A 2012 independent UK review of breast screening looked at the evidence from these trials and estimated that inviting women aged 50-70 for screening reduces mortality from breast cancer in the population invited by 20% and saves an estimated 1,300 lives a year in the UK,” she said. |
| “However, there are potential risks as well as benefits associated with breast screening, including over-diagnosis, and it is important that women are given information that is clear and accessible before they go for a mammogram.” Women should make “an informed choice” as to whether or not to attend screening, she said. | “However, there are potential risks as well as benefits associated with breast screening, including over-diagnosis, and it is important that women are given information that is clear and accessible before they go for a mammogram.” Women should make “an informed choice” as to whether or not to attend screening, she said. |